Evidence map›Paper›PMID 37665377›Full record

SynthesisNeurosurgical review2023

Antiplatelet therapy in aneurysmal subarachnoid hemorrhage: an updated meta-analysis.

Keng Siang Lee, Cheyenne Lee, Permesh S Dhillon, Ramez Kirollos, Vincent D W Nga, Tseng Tsai Yeo, Hans Henkes, Adam S Arthur, Leonard L L Yeo, Pervinder Bhogal

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neurosurgical review, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07249853 (Cilostazol for Preventing Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage), which is not on this map. Cited by 18 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 2 pooled it
5.8field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07249853 phase3not yet recruitingnot on this mapstarted 2025, after this paper: background citation

Cilostazol for Preventing Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Prospective, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial

TypeinterventionalSponsorBeijing Tiantan HospitalRan2025 to 2027Enrolled316ConditionsAneurysmal Subarachnoid HemorrhageArmsCilostazol 100 mg BID, placebo
3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.

  1. Pooled it
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  3. Indications for Dual Antiplatelet Therapy in Coil-Only Treatment of Ruptured Intracranial Aneurysms: A Narrative Review.Medical science monitor : international medical journal of experimental and clinical research · 2026
    Review
  4. Microthrombi and hypercoagulability's contribution to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2026
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 4 countries.

Keng Siang LeeDepartment of Neurosurgery, King's College Hospital, London, UK. mrkengsianglee@gmail.com.ORCID http://orcid.org/0000-0003-2308-0579
Cheyenne LeeDepartment of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK.ORCID http://orcid.org/0009-0004-2323-0973
Permesh S DhillonInterventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.ORCID http://orcid.org/0000-0003-4353-4515
Ramez KirollosDepartment of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.
Vincent D W NgaDivision of Neurosurgery, Department of Surgery, National University Health System, Singapore, Singapore.ORCID http://orcid.org/0000-0001-5256-5669
Tseng Tsai YeoDivision of Neurosurgery, Department of Surgery, National University Health System, Singapore, Singapore.ORCID http://orcid.org/0000-0003-4376-5153
Hans HenkesNeuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.ORCID http://orcid.org/0000-0002-6534-036X
Adam S ArthurDepartment of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis, TN, USA.ORCID http://orcid.org/0000-0002-1536-1613
Leonard L L YeoDivision of Neurology, Department of Medicine, National University Health System, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.ORCID http://orcid.org/0000-0002-4249-0402
Pervinder BhogalDepartment of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK.ORCID http://orcid.org/0000-0002-5514-5237
King's College London · GBNational University Health System · SGKlinikum Stuttgart · DENational Neuroscience Institute · SGNational University of Singapore · SGNottingham University Hospitals NHS Trust · GBRoyal London Hospital · GBUniversity of Tennessee Health Science Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Antiplatelet therapy (AT) may serve to reduce the effects of aneurysmal subarachnoid hemorrhage (aSAH)-induced pro-coagulant state in the cerebral circulation. Several studies, however, have delivered conflicting conclusions on the efficacy of AT post aSAH. Systematic searches of Medline, Embase, and Cochrane Central were undertaken on 27th March 2023. The primary outcome was delayed cerebral ischaemia (DCI). Secondary outcomes were symptomatic and angiographic vasospasm, good functional outcome (modified Rankin Scale [mRS] with scores 0-2), hemorrhagic events, and in-hospital mortality. Twenty-two studies reporting 4378 patients with aSAH were included in the meta-analysis. AT was associated with lower rates of DCI (RR=0.62, 95% CI: 0.43; 0.89), symptomatic vasospasm (RR=0.63, 95% CI: 0.46; 0.86), and moderate/severe angiographic vasospasm (RR=0.74, 95% CI: 0.65; 0.84), with no effect on hemorrhagic complications (RR=1.36, 95% CI: 0.77; 2.41). When analyzing only post-ictal use of AT, AT additionally favored rates of good functional outcomes (RR=1.18, 95% CI: 1.10; 1.26) and in-hospital mortality (RR=0.56, 95% CI: 0.39; 0.80). In the subgroup treated with cilostazol, AT was associated with lower rates of DCI (RR=0.40, 95% CI: 0.32), symptomatic vasospasm (RR=0.47, 95% CI: 0.33; 0.65), moderate/severe angiographic vasospasm (RR=0.75, 95% CI: 0.57; 0.98) and good functional outcome (RR=1.24, 95% CI: 1.08; 1.43). In the surgically treated aSAH subgroup, AT favored rates of symptomatic vasospasm (RR=0.55, 95% CI: 0.30; 0.98), moderate/severe angiographic vasospasm (RR=0.70, 95% CI: 0.54; 0.90) and good functional outcome (RR=1.23, 95% CI: 1.09; 1.41). In the endovascularly treated aSAH subgroup, AT was associated with lower rates of in-hospital mortality (RR=0.60, 95% CI: 0.41; 0.88). In aSAH patients, post-ictal AT is associated with benefits in terms of rates of DCI, vasospasm, good functional outcomes, and in-hospital mortality without an increased risk of hemorrhagic events.

Indexed as

Subarachnoid HemorrhageAngiographyCerebral InfarctionCerebrovascular CirculationHumansPlatelet Aggregation InhibitorsPlatelet Aggregation InhibitorsAneurysmAntiplateletIschemiaMeta-analysisNeuroprotectionStrokeSubarachnoid hemorrhageVasospasm

Identifiers

PMID37665377
PMCPMC10477151
OpenAlexW4386407567

What Socratic holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.